Connors House provides accommodation for up to 47 people who need personal care and

support. There were 37 people living at the service at the time of our inspection. The service provides care for older people some of whom may be living with dementia. Connors House is a single storey residential care service located close to Canterbury city centre.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

The service met the characteristics of Good in all areas.

¿ People and their relatives told us they felt safe living at Connors House. People were relaxed in the company of each other and of staff. People and their relatives said the quality of care was good and the service was well managed. Their comments included, “I have made friends since I moved in. The staff are all lovely and I couldn’t ask for more. They help me do the things I can’t manage anymore” and “[My loved one] is so well looked after – I can’t thank the staff enough”.

¿ People were protected from the risks of harm, abuse and discrimination and people’s health was monitored to make sure they remained as healthy as possible.

¿ People were involved in making decisions about their care and felt in control of their day to day lives. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. They were encouraged to keep busy and were offered a wide range of activities.

¿ People told us there was a ‘family’ and ‘homely’ feel at Connors House. There was a relaxed, calm and inclusive atmosphere at the service where people and staff valued each other.

¿ Staff responded quickly to people’s needs and worked closely with heath care professionals promoting ‘joined-up’ care.

¿ Management and staff worked as a cohesive team, spoke with each other respectfully and promoted an open and transparent culture.

¿ The service was well-led. The registered manager promoted an ‘open door’ policy and was approachable to and trusted by people, relatives and staff.

¿ There were effective audits to monitor the quality and safety of the service. Identified shortfalls were acted on to continually improve the service.

Rating at last inspection: At the last inspection in November 2017 the service was rated Requires Improvement overall. We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider failed to manage the risks of people falling. The provider failed to ensure there were systems and processes operated effectively to include a record of the care and treatment provided. The provider failed to effectively audit the service. We required the provider to take action to make improvements. The provider sent us an action plan detailing how they planned to address the breaches of Regulation. During this inspection we found the service had made and sustained the improvements and the breaches in Regulation had been met.

Why we inspected: This was a planned comprehensive inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 2 and 3 November 2017 and was unannounced. The previous inspection was carried out in September 2016.

Abbeyfield Connors House provides accommodation for up to 47 people who need personal care and support. There were 41 people living at the service at the time of our inspection. The service provides care for older people and people living with dementia including some with other health and mobility needs. Some people had complex needs and were not able to communicate verbally with us. Connors House is a single storey residential care service located close to Canterbury city centre. The service is split into three units – Holly and Evergreen, which support people living with advanced dementia and higher needs and Cedar and Ash, which support older people and people living with dementia. The Maple unit is the newest part of the service and accommodates older people. In each unit there are communal areas such as lounges, dining areas and bathroom facilities, a conservatory and a well-equipped hair salon. There is an enclosed courtyard with safety rubberised flooring, patios with seating, a BBQ area, fishponds, floral and shrub raised planting as well as a separate vegetable garden.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last comprehensive inspection in September 2016 the rating for the service was Requires Improvement overall and in each of the five key areas. This was because although risks to people had been assessed, they were not always reflective of people's changing needs. Medicines were mostly well managed, however, some records were not accurate and people did not always receive their medicines when they should. There was not always enough staff on duty to meet people's needs and at times people did not receive the support they needed, for example, to maintain their personal hygiene. Staff were not trained in topics that would help them provide care and support specific to people's needs, such as, End of Life Care and Palliative Care as well as Parkinson's and Epilepsy awareness. Care plans did not always provide staff with the most up to date guidance, so they could support people in an individual way. Assessed risks to people's health, such as monitoring food and fluid intake, monitoring weight or pressure reliving equipment were not managed effectively and, at times, people did not receive personalised care that enhanced their dignity. People were not always offered choices, and sometimes staff made assumptions about what drinks people would choose. The audits and checks carried out each month by the registered manager or a nominated person had not always been effective in identifying the shortfalls highlighted during our last inspection.

At this inspection we found improvements had been made, however, there were some areas that still required further work around risk assessment, record keeping, auditing and statutory notifications. A statutory notification is information about important events which the provider is required to tell us about by law.

Most risks to people had been properly assessed and actions were taken to minimise the likelihood of them happening. However, more action needed to be taken about people who experienced falls; including a more detailed audit processes to ensure risks were minimised. Other care plans were written in a person-centred way but had not always been updated to reflect people’s needs when they had changed.

Medicines were generally managed safely but records of the administration of topical creams needed to be managed more robustly.

Not all complaints had been logged, however, they had all been investigated and responded to.

People were safeguarded

This inspection took place on 19 and 20 September 2016 and was unannounced. The previous inspection was carried out in September 2015 and no concerns were identified.

Connors House provides accommodation for up to 47 people who need personal care and support. There were 41 people living at the service at the time of our inspection. The service provides care for older people and people living with dementia. Some people had complex needs and were not able to communicate verbally with us. Connors House is a single storey residential care home located close to Canterbury city centre. There are 43 bedrooms, four of which could be doubles. The service is split into three units – Holly and Evergreen, which supports people living with advanced dementia. Cedar and Ash, which supports older people and people living with dementia. Maple is the newest part of the building and accommodates older people. In each unit there are communal areas such as lounges, dining areas and bathroom facilities. There is an enclosed courtyard, patio and garden area.

The service had a registered manager, who was present throughout the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Risks to people had generally been assessed but were not always reflective of people’s changing needs. Medicines were mostly well managed however some records were not accurate and people did not always receive their medicines when they should. Medicines were stored appropriately.

There was not enough staff on duty at all times to meet people’s changing needs. At times this meant that people did not receive the support they needed, for example, to maintain their personal hygiene. Staff were not trained in topics that would help staff provide care and support specific to people’s needs. The registered manager did tell us they were seeking training in End of Life Care, Palliative Care, Parkinson’s and Epilepsy awareness. A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so.

The care and support needs of each person were different, and each person’s care plan was personal to them. Care plans, risk assessments and guidance were in place but did not always provide staff with the most up to date guidance, so that they could support people in an individual way. Assessed risks to people’s health, such as monitoring food and fluid intake, monitoring weight or pressure reliving equipment were not managed effectively.

At times people did not receive personalised care that enhanced their dignity. Staff were, however, kind and caring in their approach and respected people’s privacy.

People were not always offered choices, at times, staff made assumptions about what drinks people would choose. Staff understood people’s likes and dislikes and dietary requirements and promoted people to eat a healthy diet.

A number of audits and checks were carried out each month by the registered manager or a nominated person, but they had not always been effective in identifying the shortfalls highlighted during our inspection.

People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

Staff encouraged people to be involved and feel included in their environment. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to c

On the day of the inspection we met and spoke with the home manager, the senior care team, support workers and several people living at the home. We learnt that Abbeyfield works within the Eden principles. These principles are based on the ’three plagues of loneliness, helplessness and boredom causing the bulk of suffering for the elderly’.

The manager told us that the home had established a link to Canterbury Christchurch University and students were encouraged to study and work within the home’s framework. We saw that people had freedom of choice and were able to move freely around the home, enjoying the animals and birds as part of the life of the home. We saw a clean and tidy home. We saw storage issues, the home manager told us they were looking to increase available storage space.

We talked to the manager about consent issues and looked at care plans seeing strong family involvement. We were told that recent safeguarding concerns had been resolved with the individuals and their families using best interest meetings and advice from the local safeguarding team. One person told us they were ‘content, the food was good, and that staff were available and helpful’.

We looked at staffing including recruitment and retention. Staff told us that Abbeyfield was a supportive and creative employer. We saw the complaints and compliments files, and were shown the paperwork supporting appropriate actions with simple leaflets and flowcharts.

People living at the home, relatives and visitors all commented on how good the care was. People told us they were happy with the care and support they received at Abbeyfield Conners House.

People living at the home, visitors and relatives told us that they thought the home was clean and tidy. In addition they commented that they were treated with respect, kindness and dignity. Individual preferences concerning food were met, reviewed and changed if necessary.

People had the freedom of choice over how and where to spend their day in the home and were actively involved in the planning of the care they received. We observed that people who used this service were very relaxed and comfortable within the environment. They interacted well with the staff who worked with them and staff encouraged their independence.

During the inspection we found that there were appropriate numbers of suitable staff and staff were given the support they needed to carry out their role effectively.

People told us that they had brought in their own personal items to the home. We saw that people had personalised their rooms with their own belongings, which included photographs and ornaments. People and their relatives told us that they were able to visit at any time, which helped maintain their relationships with family and friends. The people we spoke with told us they were happy with the staff. One person told us "the staff are friendly and nice."

People said that they were treated with kindness, consideration and respect but some of them wanted to have more social activities. Some carers and staff thought that people did not always promptly receive the assistance they needed. People said that they had the necessary medical care, that they felt safe and that they liked their meals. People were confident that if they had a complaint it would be acted upon and that they thought that they had a say on improvements to their care and home.